Validation of Diabetes Prediction Scores: Does adding a high risk for depression increase the area under the curve?

BackgroundDiabetes risk scores include age, waist circumference, body mass index, hypertension, use of blood pressure medication, and metabolic and lifestyle variables. Although patients with major depressive disorder have a higher risk of diabetes, none of the diabetes risk scores includes high risk of depression as an additional item. AimTo validate three diabetes risk scores (FINDRISC, DESIR, ADA) in the Spanish population aged >45 years with the aim of predicting diabetes and to test the value of adding high risk of depression, defined as a PHQ-9 questionnaire score [&ge;]10, to the risk score with the best discriminative performance. MethodsProspective population-based cohort study in Madrid (Spain). FINDRISC, DESIR, ADA, PHQ-9, and OGTT values were measured at baseline. Participants with OGTT <200 mg/dl (n= 1,242) were followed up for a median of 7.3 years using their general practitioners electronic health record (EHR) and telephone contact. Incident diabetes was identified as treatment for diabetes, fasting plasma glucose [&ge;]126 mg/dl, a new diagnosis in the EHR, or self-reported diagnosis. At the end of the study, the performance of diabetes risk scores, including a modified original FINDRISC score with a new variable for high risk of depression (FINDRISC-MOOD), was assessed. ResultsDuring follow-up, 104 (8.4%; 95% CI, 6.8-9.9) participants developed diabetes, and 185 had a PHQ-9 score [&ge;]10. The AUROC values were 0.70 (95% CI, 0.67-0.72) for FINDRISC-MOOD and 0.68 (95% CI, 0.65-0.71) for the original FINDRISC. The AUROC for DESIR and ADA were 0.66 (95% CI, 0.63-0.68) and 0.66 (95% CI, 0.63-0.69), respectively. There were no significant differences in the AUROC between FINDRISC-MOOD and the remaining scores. ConclusionFINDRISC-MOOD performed slightly better than the other risk scores, although the differences were not significant. FINDRISC-MOOD could be used to identify the risk of future diabetes.